Your browser does not support JavaScript!
This form cannot automatically check that you have submitted all of the required fields without JavaScript.
Please be sure to submit all required fields (marked with stars).

Lindsborg Community Hospital

Online Patient Payment Center

Welcome to the Online Payment Center. You may pay your hospital, hospital physician, and clinic bills here by credit/debit card.
For your convenience please fill out the payment form below. All information is kept secure and confidential. If you have questions or need more information you may call our business office during business hours, Mon-Fri, 8 am to 5 pm, at 785 227-3308.

Thank you for allowing us to serve you.
* Name Of Patient
Name of Patient treated (note in comments if more than one)
* Account Number
Account Number from your statement - if multiple, please use the comment field
* Name of Payor
Name on the credit/debit card
  Comments Or Messages Related To Your Payment
If you have multiple accounts to pay, or have qualified for a prompt pay discount, please note those things here - it is also helpful to note if the service was in the clinic area or in the main area:
Payment Information - Only credit/debit card payments accepted at this time
Fill in the information below for the credit/debit card holder. If you are paying more than one account, please add the balances together and enter the total payment amount below.
Payment Discount
Effective June 1, 2014, a 30% discount is offered to the uninsured/self-pay patients of Lindsborg Community Hospital and/or the Family Health Care Clinic. Items that are not covered by insurance (home health visits and Care-Link are two examples) are considered 'self-pay' and are eligible for the discount. If you are eligible for the discount, you will notice that the discount will already have been calculated when you receive your statement.
Security Feature
The "Captcha" quiz has been added to the bottom of this form to provide a level of security for you. This makes for an often difficult phrase requirement. If your phrase is indecipherable, please click to the right of the entry box, the top red and white "open circular arrows" to "get a new challenge".
* Cardholder First Name
The first name of the account holder as it appears on the credit card.
* Cardholder Last Name
The last name of the account holder as it appears on the credit card.
* Amount of Payment
Format: 45.67 (Include decimal and cents. Do not use a dollar sign.)
* Card Number
* Expiration Date
* Card Code Verification Number
The three digit number on the back of your card. (Four digit code on the front of American Express.)
* Email Address
* Billing Postal or Street Address
* Billing City
* Billing State
* Billing Zip Code
5 digit zip code
* Contact Phone Number
Please provide a phone number where we may reach you regarding this payment